Delaying preterm delivery may reduce risk of disability

The question: When a fetus is no longer thriving in the womb, immediate delivery may be recommended to make the survival of the fetus more likely, even though this approach raises the risk of cerebral palsy and other disabilities. Delaying delivery for a few days allows for continued brain development, but this approach can have severe consequences as well. Does the timing of delivery affect the likelihood of a child’s being disabled?

This study randomly assigned 548 women who were 24 to 36 weeks pregnant with fetuses that were not thriving to deliver within 48 hours or to defer delivery until delaying was determined to be no longer safe. (These delays lasted an average of four days.) About 10 percent of the babies in both groups died before leaving the hospital. When the surviving children were 2 years old, examinations and testing showed that 7 percent of those in the immediate-delivery group had a disability, compared with 4 percent in the delayed-delivery group. A still-larger difference was found among those delivered before 31 weeks of gestation. Disabilities included blindness or impaired vision, deficient hearing, mental or psychological development problems and cerebral palsy.

Who may be affected by these findings? Pregnant women.

Caveats: Whether delaying delivery for longer would affect the outcome remains unclear.

Bottom line: Pregnant women carrying fetuses that are not thriving may want to discuss the possible effects of various delivery times with their doctor.

Find this study: Aug. 7 issue of The Lancet; abstract available online at www.thelancet.com.

Learn more about premature babies at www.kidshealth.org and at http://familydoctor.org..